Iatrogenic traumatic brain injury during tooth extraction

Area of Science:

• Veterinary Neurology
• Comparative Medicine
• Neurosurgery

Background:

• Progressive neurological signs in an 8-year-old Yorkshire terrier prompted referral.
• Clinical signs included circling, blindness, and hemiparesis following routine dental prophylaxis and extractions.

Observation:

• Neurolocalization identified the affected area to be the left forebrain.
• Magnetic Resonance Imaging (MRI) revealed a linear tract extending from the oropharynx into the frontal and parietal lobes.
• A frontal bone fracture was noted, consistent with iatrogenic trauma from a dental elevator slip during tooth extraction (tooth 210).

Findings:

• The case presented as a rare complication of tooth extraction: traumatic brain injury.
• The dog received empirical treatment with clindamycin.
• Significant neurological recovery was observed within four months post-injury, with a good quality of life maintained.

Implications:

• This case highlights the risk of iatrogenic brain injury during dental procedures in dogs.
• Emphasizes the need for meticulous technique, particularly during extraction of maxillary premolar and molar teeth.
• Veterinarians should be vigilant for potential complications and ensure careful handling to avoid damage to surrounding neural structures.